As with many other therapeutic modalities, clinical decisions involving blood use are not always made optimally in daily practice. Yet few data exist from methodologically sound studies on the efficacy of specific interventions designed to promote scientifically appropriate and cost-effective practice patterns. This project will develop a controlled multi-center trial of two promising educational strategies, print-based and face-to-face education, intended to improve the appropriateness of blood product utilization. From nine to twelve hospitals will be matched and randomized into three groups. One set of hospitals will receive no intervention and serve as controls. Another set (the "print-only" group) will receive educational feedback and other written material concerning optimal transfusion practice. Physicians in a third set of hospitals (the "face-to-face" group) will receive in addition personal consultation from experts in transfusion medicine, tailored to the specific practice problems encountered in each institution. Transfusion practices to be addressed will be chosen after a careful audit of current practices. Concurrent audit of targeted practices will continue throughout the life of the project. Benefit and cost analyses will be performed for each mode of intervention as an integral part of the research. The results of this work should prove valuable in conserving increasingly scarce blood resources, containing health care costs, and providing new understanding of methods to increase the appropriateness of clinical decision-making by physicians and others.